Considering the complexities of the air medical industry, completely removing all risk is a challenge. The road to progress, if not traveled in a deliberate manner, could lead to bad outcomes—this industry has seen far too many outcomes of that type.
Although many factors can lead to bad outcomes in HAA, some unfortunate events can be attributed to the very thing that gives our industry its name—helicopters. They are labor-intensive machines that have regularly scheduled maintenance. However, from time to time well-maintained helicopters simply break. Pilots spend most of their time in one primary aircraft. When maintenance issues dictate, they swap to their backup aircraft. Herein lies the problem.
Some operators have a fleet of almost identical aircraft. They have the same fuselage equipped with the same avionics. This makes a transition from one aircraft to another relatively simple. However, there are other operators who are not so lucky. The pilot may have a twin-engine primary aircraft, and when maintenance warrants, they may be asked to swap into a single-engine machine as the backup aircraft. The pilot is required to be instantly familiar with a completely different avionics package that he or she may not have operated in months. This could form a link in an accident chain.
Over the past decade, we have seen great advancements in technology. As pilots, we have more data at our fingertips than we could have even imagined 20 years ago. Every operator’s desire is to equip their pilots with tools that will increase productivity and revenue, and reduce risk. Knowledge is power, but there are challenges with changes. Differences in the functionality of avionics systems create challenges when swapping aircraft. It’s difficult to stay proficient when operating a system that you may only see a few times every six months.
The pilot who can stay proficient at both the Garmin 430 and Garmin 650, when they are primarily flying one or the other, is doing her homework. Now combine this with the fact that this system may be in an airframe she is not familiar with. It can be a recipe for a bad outcome. I had a pilot tell me, “On my primary aircraft, both searchlight controls are located on my collective. On my backup, there is one light toggle switch on my collective right beside the other guarded switch that dumps my hydraulic system. As you circle that scene at 2:00 a.m., don’t forget which aircraft you’re flying.”
That was good advice.
These are a issues faced by HAA pilots and flight teams. Our job at NEMSPA is to discuss situations faced by today’s team. We want to help create solutions that can trap errors, and prevent bad outcomes. So, the question is: How do we do that? Well, the quick answer is we standardize the fleet. But that is easier said than done. To standardize takes time and money. For some operators, operational restraints make that difficult.
In the meantime, how can we minimize the chances of a bad outcome? Let’s start with an industry expectation that we need disciplined professionals in our field. That might mean pilots spending some time in the backup aircraft before they are ready to take a patient transport flight. I remember being told as a young EMS pilot to go “build my nest” as part of my preflight. That involved going through an abbreviated flight. This included locating and setting up my radios, locating my crank button, finding the autopilot, reviewing my limitations, accessing my checklist and anything else that I needed to feel comfortable when the tones went off. I have a friend that I flew with for several years. Tom is quite a flight nurse. He is the guy who will make flash cards and spend time reviewing terms and procedures. Tom is a professional. His approach should be familiar to those of us sitting directly behind the cyclic. Take a little extra time and be deliberate in your approach. Conduct your preflight using the checklist—line by line. Put your finger on every single switch, control, and feature of your backup. Don’t takeoff until you are sure you know how everything works.
An anecdote: Once, when flying a patient in a backup, the crew-call tone went off in my helmet. I asked the crew, “Are you guys calling me? I can hear you, stop beeping me.” They assured me they weren’t pressing the call button. So I flew all the way to the receiving facility with that tone in my ears. As it turned out, on that aircraft the call tone had somehow been crossed with the radar altimeter alert tone, and when I made an approach I triggered the rad-alt alert. I didn’t understand what was going on with that aircraft until a paramedic who was familiar with it said, “That’s the radar altimeter alert tone. It’s different on this helicopter.” I learned my lesson: use every resource!
How about you? Do you have a tried and true approach to taking the guesswork out of swapping to your backup aircraft? Please feel free to send me an email at President@nemspa.org